封闭式负压吸引联合自体游离皮片移植治疗下肢静脉性溃疡的临床研究

Vacuum sealing drainage combined with autologous free skin graft in the treatment of venous leg ulcer: a comparative study

目的探讨封闭式负压吸引(VSD)联合自体游离皮片移植与传统皮片移植在治疗下肢静脉性溃疡(VLU)的疗效对比。方法选择32例VLU病人,其中16例行VSD封闭引流联合自体游离皮片移植的方法进行治疗(观察组),16例采用传统皮片移植治疗(对照组),观察记录创面愈合情况、术后不良事件发生情况、换药次数、住院时间。结果 32例病人均溃疡愈合出院,观察组术后第7天溃疡愈合面积95%及以上者明显高于对照组(81.3%vs 43.8%,Uc=2.194,P<0.05);术后观察组皮片感染率明显低于对照组(0 vs 25%,χ~2=4.6,P<0.05);住院期间,观察组换药次数少于对照组[(7.1±1.3)次vs(19.1±5.5)次,χ~2=12.0,P<0.05];总体住院时间明显缩短[(13.9±3.0)d vs(25.1±5.4)d,χ~2=10.3,P<0.05]。随访期间两组病人均无复发病例。结论 VSD联合植皮术在治疗VLU较传统植皮术具有明显优势,可明显提高溃疡面植皮愈合率,降低创面感染率,减少换药次数,缩短住院时间,值得在临床上推广应用。

Objective To investigate the curative effect of vacuum sealing drainage combined with autologous free skin graft with the traditional skin graft in the treatment of venous leg ulcer. Methods 32 patients of venous leg ulcer in our hospital were analyzed. VSD combined with autologous free skin graft were managed in 16 cases. Meantime, traditional skin graft were used in 16 patients as control group. The ulcer healing rate,postoperative adverse events,switching frequency and hospital days were recorded. Results All 32 cases got ulcer healing. The research group got an higher proportion at ulcer healing rate （81.3% vs 43. 8% , Uc =2. 194 ,P 〈0. 05） ,a lower infection rates （0vs 25%, X2 =4. 6, P 〈0. 05）, a less switching frequency [ （7.1 ±1.3） m （19.1 ± 5 .5 ）, =12.0, P〈0. 05] and short hospital days [ （13.9 ±3.0） （25. 1 ±5.4）,X2 =10.3, P〈0. 05] than control group. There were no recurrence cases in bothgroup. Conclusion VSD combined with autologous free skin graft has obvious advantages compared with traditional skin graft in the treatment of VLU. It can improve the ulcer healing rate,reduce the wound infection,down the switching frequency,shorten hospital days and was worthy of applying.